The family of Tim Bowers carved a cross out of the tree from which Bowers fell Saturday. / The Indianapolis Star, courtesy of Robert Steinke

by Ryan Sabalow and Kristine Guerra, The Indianapolis Star

by Ryan Sabalow and Kristine Guerra, The Indianapolis Star

DECATUR, Ind. -- It started out as a typical fall Saturday afternoon inside Abbey and Tim Bowers' home. The newlyweds kicked back and watched some TV before he said goodbye. As he so often did this time of year, he was going hunting. He'd be home a little after dark. Hopefully, with a nice buck.

Just hours later, Tim woke up in the hospital. He couldn't move. His family told him they'd asked the doctors to bring him out of a drug-induced coma. They had terrible news - and a horrific question to ask.

He had fallen 16 feet as he was climbing to his tree stand, and he had shattered his spine. He likely would spend the rest of his life connected to a breathing machine, unable to walk and never able to hold the baby that Abbey was carrying in her womb. Would he rather be disconnected from the respirator?

Tim Bowers, just 32 years old, decided it was his time.

"The last thing he wanted was to be in a wheelchair," Abbey Bowers said Wednesday. "To have all that stuff taken away would probably be devastating. He would never be able to give hugs, to hold his baby. We made sure he knew that, so he could make a decision. Even if he decided the other thing, the quality of life would've been very poor. His life expectancy would be very low."

He died Sunday, about five hours after his breathing tube was removed. He spent his final hours with his family and friends, about 75 of whom gathered inside the hospital's waiting room. They prayed and sang songs.

Bowers' choice to end his own life raises provocative questions for patients, medical ethicists and health care providers.

Courts have repeatedly upheld that an adult fully aware of his or her surroundings and medical condition has every legal right to choose to be removed from life support. But his choice was particularly unusual because he made it himself, just minutes after learning his fate.

More often, the heart-wrenching call to remove life support is left to relatives. Even when a patient has outlined his wishes for end-of-life care, the decision can tear families apart.

Tim Bowers' sister, Jenny Shultz, an intensive care nurse in Las Vegas, has seen it happen in her job. But her medical training also meant she understood the severity of her brother's injuries. His C3, C4 and C5 vertebrae were crushed.

Though his brain was not injured, his body was irreparably broken. Surgery could fuse the vertebrae, but that would only allow Bowers to sit up. He might live the rest of his life in a rehabilitation hospital, relying on a machine to help him breathe.

Shultz said her brother never wavered in his decision to die.

"I just remember him saying so many times that he loved us all and that he lived a great life," she said. "At one point, he was saying, 'I'm ready. I'm ready.'"

Dr. Paul Helft, director of the Charles Warren Fairbanks Center for Medical Ethics in Indianapolis, said cases in which the patient makes the decision usually involve a debilitating illness such as Lou Gehrig's disease, which compromises the body but leaves the mind intact.

"We give patients autonomy to make all kinds of decisions about themselves," he said. "We've recognized that it's important that patients have the right to self-determination."

Art Caplan, director of the medical ethics program at New York University's Langone Medical Center in New York City, said that even though Bowers made it abundantly clear he wanted to die, his doctors might have faced a dilemma of sorts.

Caplan said that many patients facing a horrific injury, such as painful burns, disfigurement or paralysis, say initially that they don't want to live, the pain and horror of their injuries are so severe.

Caplan said that sometimes the patients change their mind if given time to think about their situation and after speaking with their spiritual advisers and their families.

"The issue is: Should you say, 'Look, let's try this for a week or two to see if you can adjust and then we'll take your breathing tube away?'" Caplan said. "Because initially after a terrible injury or a mutilating injury or a terrible burn, pain and disfigurement, everybody is like, 'I can't go on.' Almost a hundred percent say, 'I don't want to live like this.'"

What made Caplan more comfortable about Bowers' decision was that Shultz said her brother recently told his wife he never wanted to spend his life in a wheelchair.

"At least you're pretty sure - because you've had that conservation and know his views - he's consistent," Caplan said. "That's a big help in this case."

Shultz said that after the doctors woke up her brother - the youngest of four siblings - he wanted to talk but couldn't because the ventilator tube was still in place.

She told him that the doctors were not sure how long he would live if the tube were removed. But when she asked whether he wanted the tube reinserted if he started struggling to survive, Bowers shook his head no.

"We just asked him, 'Do you want this?'" she said. "And he shook his head emphatically no."

Doctors asked Bowers the same questions and got the same responses. Then they removed the tube.

Abbey Bowers said she and Tim had been together for about three years. They were married in August at St. Mary of the Assumption Catholic Church.

"He always wanted a great big wedding to show me off or something, I don't know," she said. "We wanted everybody there. It turned out being big."

When asked about his decision, she tried her best to find the words.

"I completely understood," she said, "but I was devastated because I didn't have much time with him."